Psoriatic arthritis: Is there a relationship of severity of nail disease to skin or joint disease?

To examine the relationship between the severity of nail disease and severity of both skin and joint disease as well as functional assessment among psoriatic arthritis [PsA] patients. Thirty two patients were included in the current study. Pattern of arthritis was recorded and severity of joint disease was assessed using modified Ritchie index [adding DIPs, lumbar spine and sacroiliac joints] and scored as mild, moderate and severe. Psoriatic skin patterns were recorded and severity of skin disease was assessed using the percentage of body surface area [% BSA] affected with psoriasis. Severity of nail disease was assessed using Psoriasis Nail Severity Score [PNSS] where all the 20 nails were scored for pitting, onycholysis, hyperkeratosis and dystrophy. Functional assessment was done using HAQ. Finally, the presence of HLA-B17 and HLA-B27 were investigated. Pattern of arthritis was as follows: polyarthritis was found in 19 patients [59.4%], oligoarthritis in 7 [21.9%], spondyloarthropathy in 4 [12.5%], DIPs in 2 [6.2%] and arthritis mutilans was not found. Modified Ritchie index was mild in 11 patients [34.4%], moderate in 18[56.3%] and severe in 3 [9.3%]. As for skin disease pattern, psoriatic plaques were found in 25 patients [78.2%], guttate in 4[12.5%], combined guttate and plaques in 2[6.2%] and pustular psoriasis in 1[3.1%].No erythrodermic or discoid pattern were found. The percentage of involved BSA ranged from [2.8-44%]. Nail disease was detected in 26 patients [81.2%] and was distributed as follows: 6 patients [23%] scored PNSS > 10, 13[50%] scored 10-19, 5[19.4%] scored 20-29 and 2[7.6%] scored > 30.PNSS had no correlation with age or duration of arthritis but had significant positive correlation with skin disease duration [p< 0.01] and with%BSA [p<0.01]. Also, PNSS had positive correlation with modified Ritchie index but not with HAQ which was found to correlate with modified Ritchie index [p<0.05]. Low PNSS scores were found in positive HLA-B27 and not in positive HLA-B17 patients but overall, no significant correlation were found between them. PNSS, as a simple and practical method, could be used as a good indicator for assessment of nail disease severity among psoriatic arthritis patients. Also it correlates with duration and severity of skin involvement and severity of joint disease. Research for disease pathogenesis at genetic and cellular level is still needed to understand the true link between psoriatic nail, skin and joint disease

Acute renal failure in jaundiced-isoimmunized full term neonate

This study included 85 full-term newborns with unconjugated hyperbilirubinemia, due to ABO and RH incompatibility and renal impairment as well as 20 healthy, age and sex matched full-term newborns as a control group. None of the cases showed any stress factors which may cause renal failure. All cases were subjected to full clinical examination, abdominal ultrasonography to exclude cases with congenital renal abnormalities, laboratory investigations of blood were done at the 5th day then repeated at 30th day of postnatal life for follow up. According to the investigations, the patients were subdivided into 2 groups: 25 patients with acute renal failure [ARF] and 60 patients without acute renal failure [non ARF]. They represent 4.2% and 10.1%, respectively. of the total admissions of the jaundiced, isoimmunized full-term newborns in the NICU in one year [596 neonates]. Follow up studies for one month revealed that renal functions were normalized in cases with non-ARF except the beta 2 microglobulin, while cases with ARF still have significantly higher differences in all the studied parameters when compared to the control group after one month except for urine pH and specific gravity. In conclusion, renal impairment should be expected in cases having total serum bilirubin >25 mg/dL. They should be closely monitored regarding their renal functions for at least one month of postnatal life. Those who develop ARF should be followed up for a longer period